MUNCIE, Ind. – It's been almost a year since U.S. Surgeon General Dr. Jerome Adams issued an advisory urging more Americans to keep naloxone readily available. Also referred to as the brand name, Narcan, the medication reverses an opioid overdose and can save lives by doing so.

Delaware County emergency personnel are no strangers to the havoc opioids wreak, nor are they strangers in having to administer the antidote. In the past three years, county EMS has given more than 1,400 doses of Narcan.

But by no fault of their own, first responders can only make it to a place of an overdose so quickly, depending on when – and if – they’re called.

Indiana Recovery Alliance ran a naloxone training open to the public Wednesday at Bridges Community Services, during which it was evident that community members wanted to help. The small room holding the event filled quickly. More than 30 nonprofit representatives and Muncie residents of all ages and professions gathered, prompting staff to grab extra chairs.

Overall, IRA distributed about 130 kits, or 390 doses of naloxone, to the group.

Call the attendance a sign of local intrigue, or a sign that Muncie needs the antidote – or both. Either way, the medication has our attention. So how can it help our community that's struggling with overdoses, and how effective has it been so far?

'Better safe than sorry'

During Wednesday's presentation, one of speaker Jes Cochran's biggest focuses was addressing the stigma associated with overdoses, and how it might make someone avoid calling emergency services or even tell close friends he or she is using.

Cochran said Indiana residents are five times more likely to die of an overdose than die of a car accident.

"If you told me that I could carry something in my car, and that if I came across a car accident, I could give it to someone, and they would be OK, I'm pretty sure my insurance would require that I carry it," Cochran told attendees. "But now we're talking about overdoses being the leading cause of death. Suddenly some of that stigma sticks in."

Naloxone, commonly known as Narcan, a nasal spray being used by the Quincy, Mass., Police Department to reverse the effects of opiate overdoses.(Photo: WUSA)

It was Senate Enrolled Act 406 in 2015, "Aaron's Law," that made naloxone available to all Indiana residents and not just emergency personnel, paving the way for training like the one held in Muncie.

Will Willis, a Ball State University student who attended, wanted to learn more about the medication so he could rid people of its misconceptions. Kait Williams, director of shelter services at YWCA Central Indiana, was excited to bring information back to her place of work. Alice Wilson, who utilizes Bridges' housing programming, came to the training to be prepared.

"I know there are a lot of people who struggle with substance abuse," Wilson said. "I don't know how likely the situation is that I would need to use it, but I feel like the chances are pretty good.

"So better safe than sorry."

How naloxone works

An overdose can kill in mere minutes. That’s because after being hit with the initial sense of euphoria, the central nervous system slows, causing the person overdosing to stop breathing and become unresponsive.

Of Delaware County's 74 drug-related deaths in 2018, 44 had at least one form of opiates in their systems, according to numbers provided from the Delaware County coroner's office.

Naloxone takes opiates (and only opiates) "out of the equation." When naloxone is administered, whether through nasal spray, intramuscularly or auto-injectors, the medication prevents opiates from binding to receptors in the brain. Within minutes normal breathing should resume. (The person will likely feel symptoms of withdrawal if large doses of naloxone have been administered.)

In the three years since the Indiana State Health Department awarded Delaware County 600 overdose rescue kits, local officials have seen an impact. Though county health administrator Jammie Bane didn't have specific numbers linking naloxone to a reduction of deaths — drug overdose death numbers have actually remained steady over the past three years — he does believe the use of naloxone has decreased the amount of overdose deaths the county would have seen without it, based on what he has heard. He said he has been told by "a number of first responders" of specific situations where they were able to save a life using it.

Meanwhile, the Indiana Recovery Alliance has worked to get naloxone directly into the hands of those who might need it, distributing more than 35,000 doses of naloxone across the state since 2015, with more than 2,500 overdose reversals reported, according to statistics provided by the nonprofit.

Is naloxone safe?

Each attendee during Wednesday’s training received a syringe, a dose of naloxone and an orange with which to practice. By the session's end, nearly all of the attendees walked out with at least one rescue kit. Many took more.

Chris Abert, director of the Indiana Recovery Alliance, said naloxone is "basically water to those who aren’t using opioids." In fact, he said, doctors have used it in treating newborns, and his group has even taught children as young as 7 how to administer it. He said he believes overdose reversal kits should be everywhere with a defibrillator or a fire extinguisher because he sees opioid addiction as a public health crisis, and he feels it should be just as accessible as treatment for other health problems.

Bane said general guidance at the county health department is to administer naloxone if a person's symptoms appear similar and/or there is cause to believe a drug overdose is happening. Side effects, he said, are minimal.

So, rule of thumb: if there's any indication of an overdose, go ahead and try it.

"I believe it is generally agreed that the risk it is indeed an overdose that could cause death greatly outweighs the potential of side effects occurring," Bane said.

For those who don't have naloxone close by, a person can still save a life by rescue breathing (tilting the person's head, lifting the chin, pinching the nose and breathing into his/her mouth every five seconds), which can buy time while waiting for the medication, or for emergency personnel to arrive.

Abert sometimes hears from skeptics that by providing those facing addiction with a “safety net,” it encourages them to keep using and thus decelerate recovery. His response: "What is the percentage of people that recover from death?”

“If it takes somebody 20 times to get treatment, what we need to make sure every single time is that they’re afforded the opportunity to be alive,” Abert said.

'A small piece of the puzzle'

Delaware County EMS director Jason Rogers said it's difficult to tell what programs are making the most impact locally when they're still in early stages and that naloxone is "only a small piece of the puzzle."

Rogers said what his department uses costs about $45 per dose, and the department maintains a supply of 40 to 50 doses at all times. There are also added costs with first responders’ visits. Along with the treatment comes oxygen therapy, checking of blood glucose levels, cardiac monitoring and other routine medical procedures, which make it difficult to place an actual price tag on per-patient costs.

Still, Rogers said calling 911 should be a step in the revival process, even when naloxone is on hand, noting that an overdosing individual might lack the ability to protect his or her airway. Bane added that while a dose of naloxone might help, that same person could relapse without proper medical attention.

Abert said a clearer "Good Samaritan" law that protects both the individual overdosing and the person calling from criminal charges would encourage more users to utilize emergency services.

Naloxone is available without a prescription at various Indiana pharmacies, though prices have reportedly risen in the last five years. Depending on insurance and type, the medication can run $20-$40 for a generic brand or up to $140 for a Narcan kit with two doses, according to "Time Magazine."

There are organizations, however, like Indiana Recovery Alliance, which distribute naloxone free of charge, thanks to funding from private foundations and donations. Those who attended Wednesday’s training received free naloxone and are able to distribute the medication. A local nonprofit established in June, Person-First Harm Reduction Coalition, also works to ensure naloxone consistently gets into the hands of those who need it in Muncie.

Indiana Recovery Alliance has implemented the acronym, "S.C.A.R.E. M.E." to help people remember the steps in assisting with an overdose:

Stimulation: Try to wake up the person you suspect is overdosing by yelling his/her name or doing a sternal rub.

Call 911 and let emergency personnel know the person is not breathing.

Airway: Roll the person on his/her back, clear the airway, tilt the head back and pinch the nose.

Rescue breathing: Give the person two breaths, then continue with one about every five seconds.

Evaluate if you have time to grab naloxone, if nearby.

Muscular injection in the thigh, upper arm, buttocks or hip.

Evaluate if another dose is needed and support the person until emergency personnel arrive. Have the person lie on his/her side.

These could be signs that a person is overdosing: no ability to talk, limp body, pale face, blue or gray lips or fingernails, slow and shallow breathing, choking or gurgling sounds, vomiting, foaming at the mouth, loss of consciousness